Systematic services audit of consecutive suicides in New Brunswick: the case for coordinating specialist mental health and addiction services.
OBJECTIVE
To weight the potential of promotion, prevention, and treatment programs to help establish priorities in multipronged suicide prevention strategies.


METHODS
Psychological autopsy methods served to collect information on consecutive suicides over 14 months in New Brunswick (n = 102). A panel of researchers, clinicians, provincial planners, and consumers reviewed the cases and applied a systematic needs assessment procedure to establish interventions and services received, unmet needs at the individual level, and programmatic and systemic shortcomings.


RESULTS
More than two-thirds of the individuals suffered from a depressive disorder and a similar proportion from substance (essentially alcohol) abuse or dependence; one-half also presented a personality disorder. In the last year, more than one-half had been in contact with a mental health services specialist, but less than 5% had contact with addiction services, though one-third had previous contact in their lifetime. In one-third of the cases, service gaps called for greater coordination and integration of mental health specialists and addiction services within the health care system. In one-half of the cases, system needs were found to be unmet for public awareness efforts aimed at encouraging individuals to consult health and social services professionals, and in terms of training efforts geared to improving detection, treatment, and referral for mental illness, substance-related problems, and suicidal behaviour by primary medical, social, and specialist services.


CONCLUSIONS
This study supports multipronged suicide prevention strategies that should include integrated public promotion, professional development campaigns, and better program coordination. Authorities in New Brunswick have opted to favour the latter strategy component, whose development and application must be evaluated to determine its impact on suicide rates.
Lesage
Alain
A
Centre de recherche Fernand-Seguin, Hôpital Louis-H Lafontaine, Université de Montréal, Montreal, Quebec. alesage@ssss.gouv.qc.ca
Séguin
Monique
M
Guy
Andrée
A
Daigle
France
F
Bayle
Marie-Noëlle
MN
Chawky
Nadia
N
Tremblay
Nancy
N
Turecki
Gustavo
G
D000328:Adult; D000437:Alcoholism / Q000453:epidemiology / Q000523:psychology; D054869:Clinical Audit; D015897:Comorbidity; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D005260:Female; D006292:Health Priorities; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment / Q000706:statistics & numerical data; D009509:New Brunswick; D010348:Patient Care Team; D012017:Referral and Consultation / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology; D013405:Suicide / Q000523:psychology*; D000092864:Suicide Prevention